Disability Representative, Claims Management
Overview
You will manage disability cases from intake to resolution, making routine claim determinations based on medical documentation and plan interpretation. You will review medical evidence, calculate benefits, and coordinate return-to-work strategies with physicians and employers. Working with a national team of 33,000 colleagues, you'll handle a caseload of disability claims, ensuring timely payments and compliance with ERISA regulations and FMLA guidelines. This role stands out for its focus on direct medical case management and negotiation, supported by in-house clinical resources and a culture that values work-life balance.
What You'll Do9
- 1Approve routine disability claims by analyzing medical documentation and applying plan provisions, or recommend denial to the team lead when criteria are not met.
- 2Review medical records such as attending physician statements and office notes, consulting with nurses or in-house clinicians when needed to determine disability status.
- 3Calculate and issue timely benefit payments, adjusting for SSDI and other offsets, ensuring accuracy in every case.
- 4Guide claimants through required documentation and payment timelines using phone, written correspondence, or the claims system.
- 5Set expectations with treating providers regarding return-to-work timelines and coordinate with employers for job accommodations.
- 6Manage routine disability claims against duration control guidelines, escalating complex cases to team leads or clinical case management.
- 7Coordinate investigative efforts for contested claims, arranging independent medical evaluations or surveillance when necessary.
- 8Negotiate return-to-work plans directly with physicians and employers, documenting all interactions in the claims system.
- 9Maintain professional client relationships, meeting quality program benchmarks and delivering excellent customer service on every interaction.
Requirements9
- 12+ years in claims management, benefits administration, or a related field, with a high school diploma or GED required.
- 21+ year of office or customer service experience handling phone and written communication.
- 3Demonstrated knowledge of ERISA regulations, required benefit offsets, and Social Security application procedures.
- 4Working knowledge of state and federal FMLA regulations and their application to disability claims.
- 5Familiarity with medical terminology and duration management practices, enabling accurate case assessment.
- 6Proficient in Microsoft Office and claims systems, with strong analytical and critical thinking skills.
- 7Excellent written and verbal communication, including presentation skills, to interact with claimants and clients.
- 8Ability to manage multiple priorities and deadlines in a team environment, making decisions with limited supervision.
- 9State certification in statutory leaves preferred, but not required unless state regulations mandate it.
Salary Insight
Salary not disclosed in listing
Location
Required Skills
Similar open positions
Explore active roles that match your skills and interests.
Sedgwick
VerifiedDisability Representative Sr Sedgwick Detroit Michigan
Sedgwick offers meaningful work connecting with 33,000 colleagues providing disability case management and claim determinations. Join our caring culture in Southfield MI for growth and work-life balance.
Sedgwick Claims Management Services Inc.
VerifiedWorkers Compensation Claims Associate
You will own the intake and adjustment of medical-only and minor lost-time workers compensation claims under close supervision. You will analyze compensability, determine benefits due, and document claim files with precision. You will join a collaborative team of claims professionals and support senior examiners on complex cases. This role offers structured training and a clear path to growth in claims management, with no prior experience required.
Intact Insurance Specialty Solutions
VerifiedClaim Representative Accident and Health
You will own the full lifecycle of assigned accident and health claims, from first contact to resolution, managing a caseload that spans multiple states. You will investigate coverage, assess liability, and negotiate settlements, working within a hybrid schedule from one of our regional offices. Your team includes claims adjusters and support staff, all focused on delivering fair outcomes for policyholders. This role stands out with its emphasis on recorded statements and independent settlement authority, and it offers a path to grow within a global specialty lines insurer.
7 Cs Building Maintenance
VerifiedWorkers Compensation Claims Manager Phoenix AZ
The Workers' Compensation Claims Manager leads claims portfolio across multiple states focusing on California. This role supports internal risk management and financial oversight while advocating for the company. The manager ensures carriers and TPAs handle claims fairly and efficiently. They serve as the primary company representative in all WC matters helping the CFO make informed decisions about reserves settlements and risk management.
Nationwide Children's Hospital
VerifiedSr Disability Transitional Work Consultant
Leads transitional work and return-to-work programs for employees with medical restrictions. Collaborates with stakeholders to evaluate work capacity and facilitate accommodations. Ensures safe compliant return-to-work outcomes. Manages documentation and supports case coordination.
Sedgwick Claims Management Services Inc.
VerifiedClaims Representative, Liability & BI Claims
You will own low-level general liability claims, determining benefits and negotiating settlements for a dedicated client account. You join a global claims team of 33,000 colleagues, handling claims across BI and premises liability with direct client interaction. This role offers hybrid or remote work, a flexible schedule, and clear growth paths in a company recognized for its caring culture.